Pearls in facelift management.

Facelift surgery is complex and requires a significant commitment from both patient and surgeon. This article provides a collection of surgical tips and pearls that can be applied to most facelift procedures, no matter the surgical technique. A holistic approach to patient care is discussed regarding preoperative, perioperative, and postoperative management. Within this article the authors outline details so facial plastic surgeons can provide their patients with the smoothest surgical experience and recovery.

Primary and adjunctive uses of botulinum toxin type A in the periorbital region.

Chemodenervation with botulinum toxin has become an integral part of the facial plastic armamentarium. Although eyebrow and eyelid cosmetic deformities and asymmetries have traditionally been treated by surgical intervention, Botox can now be incorporated effectively into the surgical plan. When the surgeon has a complete understanding of facial anatomy and muscular interactions, Botox can be used as a primary treatment of the periorbital region or as an adjunct to surgical procedures of the periorbital region.

Primary and adjunctive uses of botulinum toxin type A in the periorbital region.

Chemodenervation with botulinum toxin has become an integral part of the facial plastic armamentarium. Although eyebrow and eyelid cosmetic deformities and asymmetries have traditionally been treated by surgical intervention, Botox can now be incorporated effectively into the treatment plan. When the surgeon has a complete understanding of facial anatomy and muscular interactions, Botox can be used as a primary treatment of the periorbital region or as an adjunct to surgical procedures of the periorbital region.

The "pinch and slide" blepharoplasty: safe and predictable aesthetic results.

Blepharoplasty is one of the most common facial cosmetic surgical procedures. When done properly, this relatively simple operation can result in a dramatic improvement for the patient with relatively little downtime. However, when it is performed improperly, the results can be crippling for the patient and often difficult for the surgeon to correct. Standard treatments for upper eyelid dermatochalasis include surgical excision of skin, muscle, and fat. Several techniques have been described for removing some or all of these components, depending on the patients' anatomic requirements. In particular, the "pinch" technique can be used to remove either the upper eyelid skin alone or a combination of skin, muscle, and fat. While this technique is not new, its appearance in the literature is sparse. We demonstrate herein how a modified version of the pinch technique can be used to remove the central orbital fat pad by "sliding" the pad through the medial fat pad incision. This procedure maintains the integrity of the central orbital septum and the delicate structures that lie beneath.

Adjunctive applications for botulinum toxin in facial aesthetic surgery.

Botulinum toxin (Botox) has firmly established itself as one of the premier nonsurgical therapies. Recently, Botox is also being used as an adjuvant to many aesthetic procedures, both surgical and nonsurgical. This combined therapeutic use for Botox may not only create an added benefit toward facial rejuvenation but may create a synergistic one as well. This article examines such uses for Botox and reviews the current medical literature.

Middle-vault narrowing in the wide nasal dorsum: the "Reverse Spreader" technique.

The middle vault is a transition zone between the nasal tip and nasal bones and plays an important role in profile, tip projection, tip rotation, and tip support. This report presents an alternative to conventional techniques specific to the middle nasal vault for a patient population with particular nasal features. A narrow middle vault with internal nasal valve collapse is functionally and aesthetically addressed by the insertion of spreader grafts. However, the inverse of this situation is sometimes encountered. A patient with a broad middle vault and without internal nasal valve collapse will benefit from reduction of the horizontal width of the cartilaginous dorsum, which is in effect the reverse of spreader grafts. This effect is achieved by excising a vertical wedge-shaped strip of cartilage that follows the length of the upper lateral cartilage at the junction of the upper lateral cartilage and the dorsal nasal septum.